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Ultrasound of the ligaments
Last reviewed: 20.11.2021
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Bundles are fibrillar structures that connect two bone structures to each other. There are two types of ligaments: intraarticular and extraarticular. This difference defines a differentiated approach to their investigation. Since ultrasound examination of intraarticular ligament is difficult due to bone structures, the MRI method is used to evaluate them. Ultrasound same study is more informative for assessing the condition of extraarticular ligaments.
Methods of research.
Ultrasound examination of the ligaments should begin with the identification of two bone structures to which the ligament is attached. By connecting them with an imaginary line, the sensor is mounted on the longitudinal axis of the bundle. To avoid the effect of anisotropy, the test ligament should be perpendicular to the ultrasound. Here, as well as for tendons, linear sensors with a frequency of 7.5-15 MHz are used.
Echocardiography is normal.
According to the echostructure, the ligaments are similar to tendons. Extra-articular ligaments look like hyperechoic fibrillar structures. They consist of collagen tissue and connect one bone to the other, for example, the inner lateral ligament of the knee joint or a patellar ligament. However, some of them, for example, the outer lateral ligament of the knee joint,
Hypoechoic due to additional fibers going in the other direction. Intra-articular ligaments, for example, cruciate ligaments of the knee joint, are visualized as hypoechoic structures, since their course is not perpendicular to the ultrasound ray.
In transverse scanning, ligaments are often difficult to distinguish from surrounding tissues, so they are scanned in parallel to their long axis. On MP-tomograms, the ligaments in the T1 and T2-weighted images have a low intensity.
Pathology of ligaments.
Stretch and tear. Stretchings and ligament ruptures occur when the excessive volume of movement in the joint is forced. The most common damage to the ligaments of the knee joint. The degree of damage to the ligaments can be different: from stretching, incomplete rupture to complete rupture with detachment of the bone fragment. When stretching, the integrity of the ligament can be preserved, but a thickening can be observed at the stretch site due to edema. There may be interstitial and partial edge ruptures of the ligament fibers both at the site of attachment to the bone and in its central part. The ligament function can be partially preserved.
Treatment for intramuscular ruptures is symptomatic with restriction of active movements in the joint. With incomplete marginal ruptures, it is necessary to immobilize for 2-3 weeks and limit the load on the joint for 4 months. With significant damage, complete ligament ruptures occur with complete loss of ligament function. In the place of rupture, hematoma and edema of surrounding tissues appear. In the absence of restorative treatment, the zone of rupture of the fibers is replaced by a scar, which leads to instability in the joint, the development of degenerative changes and repeated injuries. Treatment consists in repositioning the fibers of the torn ligament. Thus, it is important not only to diagnose a ligament rupture, but also to determine its degree, as this affects the choice of treatment tactics.
"Knee of the jumper". Local tendonitis often occurs with a constant load of jumpers, runners for long distances, volleyball players and basketball players. He was called the "knee jumper" and "inverted knee jumper." In this case, the ligament thickens either in the area of its attachment to the patella, or in the area of attachment to the lumbar bone, respectively. Damage to the ligament is combined with an effusion in the area of the podnkolennoy bag.
Against the background of chronic tendinitis, ruptures of the ligament easily arise. With complete rupture, the fibrillar structure of the ligament disappears, in its place there is a hematoma, and also an effusion into the podnkolennuyu bag. At partial rupture the fibrillar structure of the ligament is partially preserved. With chronic tendinitis, the place of attachment of the ligament to the bone appears calcifications, areas of fibrosis.
Disease of Ostud-Schlatter. This is a kind of chondropathy affecting its own patellar ligament and tuberosity of the lumbar bone. It occurs as a result of repeated microtrauma. In this disease, the patient develops spontaneous pain, which is aggravated by bending the knee joint. The distal part of the patellar ligament is thickened and hypoechoic areas with fragments of the anterior tuberosity of the lumbar bone are determined in it. UZ-signs are the same as in inflammation of the ligament, but with this pathology there are bone inclusions in the ligament.